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Table Of Contents
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Introduction
Background
SNOMED CT terminology provides a common language that enables a consistent way of indexing, storing, retrieving, and aggregating clinical data across specialties and sites of care.
SNOMED International maintains the SNOMED CT technical design, the content architecture, the SNOMED CT content (includes the concepts table, the descriptions table, the relationships table, a history table, and ICD mappings), and related technical documentation.
Purpose
This document provides a summarized description of the content changes included in the January July 2020 release of SNOMED Clinical Terms® (SCT) International Release.
It also includes technical notes detailing the known issues which have been identified and agreed to be released. These are known content or technical issues where the root cause is understood, and the fix has been discussed and agreed to, but has yet to be implemented.
The SNOMED International Release Notes are available alongside the January July 2020 International Edition release.
Scope
This document is written for the purpose described above and is not intended to provide details of the technical specifications for SNOMED CT or encompass every change made during the release.
Audience
The audience includes National Release Centers, WHO-FIC release centers, vendors of electronic health records, terminology developers and managers who wish to have an understanding of changes that have been incorporated into the January July 2020 International Edition release.
Content Development Activity
Summary
Continuous quality improvement and enhancement of existing content is an ongoing process undertaken by SNOMED International in preparation for every release. The January July 2020 International Release has seen a continuation of the work driven by contributions from: Kaiser Permanente i.e. Convergent Medical Terminology (CMT), Global Medical Device Nomenclature Agency (GMDNA), Orphanet and other domain specific collaborations as well as requests received via the Content Request System (CRS).
Additionally quality improvement activities are in progress for new and enhanced content through advanced via project driven initiatives which are also summarized below. Also included as Additional, work items for impacting every release are various updates to the SNOMED CT derived maps such as ICD-10 and ICD-O and details O; details are also included in these release notes. Information
Information about editorial decisions may be found in the SNOMED CT Editorial Guide, ; mapping guidance for ICD-10 can be found at this link https://confluence.ihtsdotools.org/display/DOCICD10
Important - Content Changes Introduced After the July 2020 Member Release, and before the July 2020 Production Release
Two additional concepts (plus their related components) were added to the July 2020 release after the Member release on 30 June 2020. They are therefore included in the final, Public release of the July 2020 International Edition.
The two new concepts are detailed elsewhere in these release notes however for information the new concepts are:
- 895231008|Not detected in pooled specimen (qualifier value)|
- 890195008|International Health Terminology Standards Development Organisation Global Patient Set module (core metadata concept)|
Note | ||||
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Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter. At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A | ||||
Note | ||||
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Inactivation reason of LIMITED/WAS_A is not allowed for any new content inactivations after the July 2018 release. The WAS_A association refset has not been updated thereafter. At the Editorial Advisory Group meeting in April 2019, agreement was reached to discontinue the maintenance of WAS_A relationships when inactivating concepts that have a historical association to an inactive concept. When changes are made to a historical relationship for a concept that was previously inactivated using WAS_A, effort will be made to assign a new historical relationship that facilitates traceability of the concept (e.g. DUPLICATE or AMBIGUOUS) as opposed to NON-CONFORMANCE TO EDITORIAL POLICY. Existing WAS_A relationships will be inactivated in a future release once a plan for batch reassignment of historical relationships has been developed. Until then, SNOMED International will not continue to use or maintain WAS_A relationships. |
Content Quality Improvement
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COVID-19
An INTERIM International Edition Release was produced in March 2020 as part of the ongoing global effort to tackle the Coronavirus outbreak and included the updated Coronavirus descriptions for Members and implementers.
New components March 2020 Interim release |
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840544004 3947197012 Suspected disease caused by severe acute respiratory coronavirus 2 (situation) 840544004 3947195016 Suspected disease caused by SARS-CoV-2 840544004 3947196015 Suspected disease caused by severe acute respiratory coronavirus 2 840544004 3950926016 Suspected COVID-19 |
840534001 3947192018 Severe acute respiratory syndrome coronavirus 2 vaccination (procedure) 840534001 3947193011 SARS-CoV-2 vaccination 840534001 3947194017 Severe acute respiratory syndrome coronavirus 2 vaccination 840534001 3950925017 COVID-19 vaccination |
840533007 3947189017 Severe acute respiratory syndrome coronavirus 2 (organism) 840533007 3947190014 SARS-CoV-2 840533007 3947191013 Severe acute respiratory syndrome coronavirus 2 |
840546002 3947186012 Exposure to severe acute respiratory syndrome coronavirus 2 (event) 840546002 3947187015 Exposure to SARS-CoV-2 840546002 3947188013 Exposure to severe acute respiratory syndrome coronavirus 2 |
840539006 3947183016 Disease caused by severe acute respiratory syndrome coronavirus 2 (disorder) 840539006 3947184010 Disease caused by severe acute respiratory syndrome coronavirus 2 840539006 3947185011 COVID-19 |
840536004 3947180018 Antigen of severe acute respiratory syndrome coronavirus 2 (substance) 840536004 3947181019 Antigen of severe acute respiratory syndrome coronavirus 2 840536004 3947182014 Antigen of SARS-CoV-2 |
840535000 3947177019 Antibody to severe acute respiratory syndrome coronavirus 2 (substance) 840535000 3947178012 Antibody to severe acute respiratory syndrome coronavirus 2 840535000 3947179016 Antibody to SARS-CoV-2 |
A further set of new concepts have been added for the July 2020 release
New concepts July 2020 release |
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Clinical finding hierarchy: 138389411000119105| Acute bronchitis caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 870590002| Acute hypoxemic respiratory failure due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 870589006| Acute kidney injury due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 674814021000119106| Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 189486241000119100| Asymptomatic Severe acute respiratory syndrome coronavirus 2 infection (finding) 870577009| At increased risk of exposure to Severe acute respiratory syndrome coronavirus 2 (finding) 119731000146105| Cardiomyopathy due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 119741000146102| Conjunctivitis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 119981000146107| Dyspnea caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 1240561000000108| Encephalopathy due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 119751000146104| Fever caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 1240541000000107| Infection of upper respiratory tract caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 880529761000119102| Lower respiratory infection caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 866151004| Lymphocytopenia due to Severe acute respiratory syndrome coronavirus 2 (disorder) 1240531000000103| Myocarditis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 1240521000000100| Otitis media due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 882784691000119100| Pneumonia caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 870591003| Rhabdomyolysis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 870588003| Sepsis due to disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder) 1240581000000104| Severe acute respiratory syndrome coronavirus 2 detected (finding) 1240591000000102| Severe acute respiratory syndrome coronavirus 2 not detected (finding) 866152006| Thrombocytopenia due to Severe acute respiratory syndrome coronavirus 2 (disorder) |
Observable entity hierarchy: 871555000| Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 (observable entity) 871559006| Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 in bronchoalveolar lavage fluid (observable entity) 871556004| Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 in nasopharyngeal swab (observable entity) 871557008| Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 in oropharyngeal swab (observable entity) 871558003| Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 in sputum (observable entity) 871560001| Detection of ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction (observable entity) 871562009| Detection of Severe acute respiratory syndrome coronavirus 2 (observable entity) 871552002| Detection of Severe acute respiratory syndrome coronavirus 2 antibody (observable entity) 871553007| Detection of Severe acute respiratory syndrome coronavirus 2 antigen (observable entity) 1240461000000109| Measurement of Severe acute respiratory syndrome coronavirus 2 antibody (observable entity) 1240471000000102| Measurement of Severe acute respiratory syndrome coronavirus 2 antigen (observable entity) |
Situation with explicit context hierarchy: 688232241000119100| Disease caused by Severe acute respiratory syndrome coronavirus 2 absent (situation) 292508471000119105| History of disease caused by Severe acute respiratory syndrome coronavirus 2 (situation) |
Specimen hierarchy: 461911000124106| Swab specimen from oropharynx (specimen) |
Substance hierarchy: 870361009| Immunoglobulin G antibody to Severe acute respiratory syndrome coronavirus 2 (substance) 870362002| Immunoglobulin M antibody to Severe acute respiratory syndrome coronavirus 2 (substance) 1240411000000107| Ribonucleic acid of Severe acute respiratory syndrome coronavirus 2 (substance) |
Qualifier value hierarchy: 895231008|Not detected in pooled specimen (qualifier value)| |
Updates about content relating to COVID-19 can be found here SNOMED CT COVID-19 Related Content
Any concepts in scope for SNOMED CT to ICD-10 mapping have been mapped and adhere to the World Health Organization current guidelines.
Content Quality Improvement
SCT Statistics | |
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Domain | #New concepts |
SNOMED CT Concept (SNOMED RT+CTV3) | 3876 |
Body structure (body structure) | 306 |
Clinical finding (finding) | 2064 |
Event (event) | 4 |
Environment or geographical location (environment / location) | 19 |
Observable entity (observable entity) | 117 |
Organism (organism) | 135 |
Pharmaceutical / biologic product (product) | 441 |
Physical object (physical object) | 89 |
Procedure (procedure) | 299 |
Qualifier value (qualifier value) | 66 |
Record artifact (record artifact) | 2 |
Social context (social concept)| | 8 |
Situation with explicit context (situation) | 129 |
Specimen (specimen) | 8 |
Substance (substance) | 137 |
Staging and scales (staging scale) | 33 |
SNOMED CT Model Component (metadata) | 19 |
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SCT Statistics for July 2020 Release | |
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#total | |
Newly inactivated concepts | 2073 |
Newly reactivated concepts | 13 |
Changed Fully Specified Name | 986 |
Inactivated descriptions (synonym only) | 1434 |
New descriptions (synonym only) on existing concepts | 2251 |
Reactivated description (synonym only) | 15 |
New inferred relationships | 4088 |
Changed inferred relationships | 10766 |
Changed definitional status | 1607 |
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Body structure
New body structure concepts: 306
Completion of the revision of hierarchical relationships provides stable anatomy content and improves the quality of classification results in other hierarchies.
The plan is to implement the new anatomy concept model over forthcoming releases. There are approximately 35,000 anatomy concepts to be modeled by different types of 'part of' relationships. The new model will enable the automatic generation of hierarchies to further improve quality and consistency. The concept model for over 14,000 structure concepts has been tested by batch import of axioms into the authoring platform. In order to gather feedback and evaluate the potential impact on the classification to content in extensions, a demonstration release of the anatomy model changes is planned for January 2021.
Abdomen/Pelvis
Updated modelling for diagnostic imaging procedures related to the changes for abdomen terminology, e.g. CT, MRI, SPECT CT have been implemented.
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Body structure
New body structure concepts: 467
The new anatomy concept model implements the enhanced Description Logic features, e.g. reflexive and transitive properties, additional axioms for consistent logical modeling. The inferred IS_A relationships from the OWL anatomy ontology have been reviewed and the changes have been implemented in production. Potential impact to other hierarchies for example clinical finding, procedure, observable entity, situation with explicit context, were also reviewed as part of the project. Revision of hierarchical relationships for all body systems has been completed. The changes in the 2020 January release include:
Changes to hierarchical relationships in body structures:
• Nervous system: 1,303
• Respiratory system: 402
• Hematological system: 157
• Immune system: 132
• Lymphoreticular system: 144
• Integumentary system: 513
• Special senses organ system: 413
• Endocrine system: 88
Review of potential impact and most issues addressed in other hierarchies for example disorder, procedure, by body system:
• Nervous system: 5,714
• Respiratory system: 2,264
• Hematological system: 844
• Immune system: 772
• Lymphoreticular system: 696
• Integumentary system: 5,970
• Special senses organ system: 5,080
• Endocrine system: 1,123
Quality Improvement in the Body Structure Hierarchy
Nervous system:
Hierarchical relationships and concepts that are descendants of 25087005 |Structure of nervous system (body structure)| have been reviewed and improved. The appraisal included rationalization of the peripheral nerves and cranial nerves to ensure that a branch of a specified nerve is not subordinate to the nerve from which it originates, but has an IS_A relationship to the regional nerve structure that covers the entire anatomical boundaries of every branch of that nerve. Any relationships that did not fulfil this rule have been corrected.
It has been identified that the use of the term ‘cerebrum’ is ambiguous within clinical terminology historically: sometimes referring to the brain as a whole, and on other occasions referring to the more limited meaning of the cerebral hemispheres. In order to clarify the semantics of ‘cerebrum’, the concept 83678007 |Structure of cerebrum (body structure)| location and definition has been elucidated using the following statement: ‘The cerebrum is the regional structure of the brain, which is the adult equivalent of the forebrain or prosencephalon. It is constituted by the structural derivatives of the telencephalon and diencephalon including the cerebral hemispheres, epithalamus, thalamus, hypothalamus, lateral ventricles and third ventricle. This definition is harmonious with the Federation of Association of Anatomist Second Edition (2019) Part V Terminologia Anatomica'.
Revision of concepts for abdomen and pelvis regions:
The relationships of the walls, cavities and contents of the abdomen and pelvis have undergone intensive review and re-work.The notion of ‘abdomen’ in clinical practice can vary between different specialties and circumstances; for example, ‘abdomen’ in natural language can be used to refer to, but is not limited to, the following concepts:
• Abdominopelvic cavity
• Abdominopelvic cavity excluding the true pelvic cavity (Abdomen proper cavity)
• Abdominopelvic cavity and/or content (Intra-abdominopelvic structure)
• Intra-abdominopelvic structure excluding intra-pelvic structure of true pelvis
• Intra-abdominopelvic structure and/or anterior abdominal wall
• Intra-abdominopelvic structure and/or anterior abdominal wall, excluding intra-pelvic structure
of true pelvis (Abdomen proper)
• Abdominal segment of trunk
• Abdominal cross-sectional segment of trunk
SNOMED International considers the most commonly used clinical variant referred to as ‘abdomen’ to be 818983003 |Structure of abdominopelvic cavity and/or content of abdominopelvic cavity
Intra-abdominopelvic structureand/or anterior abdominal wall
, excluding intra-pelvic structure of true pelvis (Abdomen proper)(body structure)|, which in SNOMED CT is now the only concept using ‘Abdomen’ as a synonym. Revision of the inguinal region, anal structures and vaginal structures have been implemented in order to address some historical sub-optimal classification results.
Further detail can be found at https://docs.google.com/document/d/1gxkcEYf89eJl0RJG8-S2w4zOdpF8R2sn5SHx7InWxZI/edit?usp=sharing
Coronary artery
Updated left coronary arteries following the pattern for branches of blood vessels.
Cardiac ventricle
Updated the 17 segments of left cardiac ventricle and eliminated the term 'posterior' from anatomy according to the standard from the American Heart Association.
Jaw region
The missing relationship between jaw and tooth that was reported by the Dentistry Clinical Reference Group has been resolved.
Peripheral artery
The peripheral arterial anatomy hierarchy has been augmented to improve a number of dependant sections including that of peripheral arterial diseases. The update has addressed over 100 incorrect classification results.
Mediastinum
Disorders of mediastinum are modeled by a new anatomy concept |Structure of space and/or soft connective tissue within mediastinal cavity (body structure)|. This has addressed nearly 300 incorrect classifications, such as myocarditis being classified as a type of mediastinitis.
Planned revision of Cell hierarchy in the January 2021 release
The content under 4421005 |Cell structure (cell structure)| will be updated according to the SEP model and description patterns. Descendants of 362837007 |Entire cell (cell)| will be updated to include the word ‘entire’ in all descriptions. The semantic tag ‘(cell)’ will be changed to ‘(cell structure)’. Descriptions for the rest of the concepts will be updated to include the word ‘structure’.
This improvement will reduce the potential misuse of cell concepts.
Please contact info@snomed.org with any inquiries or to submit feedback
SNOMED International considers the most commonly used clinical variant referred to as ‘abdomen’ to be 818983003 |Structure of abdominopelvic cavity and/or content of abdominopelvic cavity and/or anterior abdominal wall (body structure)|, which in SNOMED CT is now the only concept using ‘Abdomen’ as a synonym. New concepts have been added to satisfy the requirements of imaging including:
- Structure of abdominal cross-sectional segment of trunk (body structure)
- Structure of pelvic cross-sectional segment of trunk (body structure)
- Structure of abdominopelvic cross-sectional segment of trunk (body structure)
- Structure of thoracic cross-sectional segment of trunk (body structure)
The different anatomical entities in this area have all been allocated a definition in order to bring clarity to this domain. A considerable number of definitions of disorders and procedures have been reviewed and rationalized according to these clearer principles. Further work on modeling updates for disorders and procedures, such as CT and MRI related to the abdomen has been planned for the next release.
Review of Respiratory System
The hierarchical relationships for subtypes of 20139000 Structure of respiratory system (body structure) have been reviewed and improved, specifically:
- 55214000 Bronchiole structure (body structure) was removed as a child of 955009 Bronchial structure (body structure) as this was causing inappropriate classification of many concepts, the parents are now 72674008 Bronchopulmonary segment structure (body structure) and 119198002 Tracheobronchial tree part (body structure).
- Several ‘pharyngeal space concepts’ were deemed to be ambiguous and also there was some redundancy. These were modeled as pharyngeal structures however in reality they are not internal pharyngeal structures, although they are sometimes loosely described as such. Concepts using this terminology have been inactivated and relevant concepts are now organized under a new concept 789210002 Structure of peripharyngeal space (body structure).
New areas of content for Anatomy
New concepts added for Hair follicle of specific body regions.New concepts added for spinal nerve proper at different levels
.
Reference set updates
Updated and validated release file for the lateralizable body structure reference set
.Updated and validated release files for the SEP refsets
.
Clinical finding
New concepts added for clinical finding hierarchy: 1446
Note | ||||
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Approximately 149 text definitions were missing either a US or GB spelling variation - this has been rectified in the January 2020 release with implementation of new validation to identify any future issues. A small set of disorder concepts were identified with descendants that had a semantic tag of clinical finding along with a further small set of concepts that had a semantic tag of disorder but were not descendants of 64572001|Disease (disorder)|. These issues have been rectified in the January 2020 release with implementation of new validation to identify any future issues. |
New content additions include
- Wound = 40 concepts
- Abrasion = 8 concepts
- Abscess = 13 concepts
- Benign neoplasm = 38 concepts
- Burn = 44 concepts
- Chemical burn = 36 concepts
- Closed fracture = 15 concepts
- Edema = 14 concepts
- Epidermal burn = 20 concepts
- Female genital mutilation type = 7 concepts
- Fracture = 10 concepts
- Full thickness burn = 14 concepts
- Hematoma = 13 concepts
- Infected wound = 23 concepts
- Injury = 33 concepts
- Laceration = 21 concepts
- Open fracture = 35 concepts
- Open wound = 108 concepts
- Partial thickness burn = 33
- Repetitive motion disorder = 19 concepts
- Subungual hematoma = 16 concepts
- Superficial foreign body = 14 concepts
Quality Initiative
The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 release the next stage has been implemented for subsequent releases including January 2020.
Quality improvement tasks were deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modeling of content. Additionally, correction or addition of defining relationships was carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.
Total count of changes for the QI project:
- Stated: A total of 9608 concepts had changes made to the Stated relationships in the model.
- Inferred: A total of 16726 concepts affected by inferred changes.
Quality Improvement in the Clinical Finding Hierarchy
Inactivation of 33359002 |Degeneration (morphologic abnormality)|
In order to distinguish the degenerative process from the structure, 33359002 |Degeneration (morphologic abnormality)| has been inactivated as a DUPLICATE, SAME AS 107669003 |Degenerative abnormality (morphologic abnormality)|. All morphologies in the disorder hierarchy have been replaced accordingly.
Inactivation of 23583003 |Inflammation (morphologic abnormality)
In order to distinguish inflammatory process from structure, 23583003 |Inflammation (morphologic abnormality)| has been Inactivated as DUPLICATE, SAME AS 409774005 |Inflammatory morphology (morphologic abnormality)|. All concepts in the Inflammatory disorder hierarchy have been remodeled accordingly.
Revision of 129156001|Traumatic dislocation of joint (disorder)|
Traumatic dislocation concepts are being remodeled according to the new representation using DUE TO "Traumatic event". This work has been partially completed for the Jan 2020 release, resulting in the remaining subhierarchies moving from under "Traumatic dislocation of joint" to "Dislocation of joint". These remaining subhierarchies will be remodeled for the July 2020 release.
Revision of 298180004 |Finding of range of joint movement (finding)
The concepts under the subhierarchy 298180004 |Finding of range of joint movement (finding)|have been remodeled to represent the finding site of <<785818007 |Structure of joint region (body structure)| instead of <<39352004 |Joint structure (body structure)|. Range of movement of a joint region can be impacted by both bone and soft tissues, therefore the use of 39352004 |Joint structure (body structure)| was too restrictive and caused issues in other areas of the terminology.
Revision of Fracture Concepts
Added new morphologic abnormality concepts in the following areas:
- Neer classification of fracture of proximal humerus part fracture types (8 new concepts).
- Seinsheimer classification of subtrochanteric femur fracture types I through V (5 new concepts).
This work led to changing relationships and definition status to "fully defined" for 6 fracture disorder concepts. Four qualifier value "Neer" fracture concepts were inactivated and referred to the new morphologic abnormality concepts.
Updated and validated release files for the SEP refsets.
Clinical finding
New concepts added for clinical finding hierarchy: 2064
Quality Initiative
The Quality Initiative (QI) project is the implementation of the Quality Strategy. After a successful pilot project for the July 2018 release the next stage has been implemented for subsequent releases including July 2020.
Quality improvement tasks were deployed to improve internal structural consistency and ensure compliance with editorial policy related to the stated modeling of content. Additionally, correction or addition of defining relationships was carried out to accurately reflect current clinical knowledge and ensure the semantic reliability of descriptions associated with a concept.
Total count of changes for the QI project:
- Stated: A total of 6835 concepts had changes made to the Stated relationships in the model.
- Inferred: A total of 10731 concepts affected by inferred changes.
QI Project focus for July 2020 release (work has begun or been completed) | |
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1806006|Eruption (morphologic abnormality)| | 41010001|Maturation defect (morphologic abnormality)| |
708528005|Narrowing (morphologic abnormality)| | 107666005|Fluid disturbance (morphologic abnormality)| |
112639008|Protrusion (morphologic abnormality)| | 79644001|Pigment alteration (morphologic abnormality)| |
6574001|Necrosis (morphologic abnormality)| | 449735000|Structural change due to ischemia (morphologic abnormality)| |
708530007 |Obstructive morphology (morphologic abnormality)| | 5294002 |Developmental disorder (disorder)| (excluding congenital disorders) |
367651003|Malignant neoplasm of primary, secondary, or uncertain origin (morphologic abnormality)| | 125673005|Traumatic dislocation (morphologic abnormality) |
Revision of 129156001|Traumatic dislocation of joint (disorder)|
Traumatic dislocation concepts have been remodeled according to the new representation using DUE TO "traumatic event". This work was commenced in the January 2020 release and has been completed for the July 2020 release.
Birth injury
These concepts have been remodeled according to the new representation using DUE TO 'traumatic event' to be consistent with the new traumatic injury model.
Traumatic brain injury
Traumatic brain injury concepts with specified concrete ranges relating to 'loss of consciousness' have been inactivated due to their limited clinical value and lack of historical usage.
Revision of Spinal Cord Syndrome
A new concept 840721004| Incomplete spinal cord syndrome (disorder) has been created as a grouper parent to the four major subtypes of this syndrome:
- 282785008 |Anterior cord syndrome (disorder)|
- 27982003|Brown-Séquard syndrome (disorder)|
- 282786009 |Posterior cord syndrome (disorder)|
- 282787000 |Central cord syndrome (disorder)|
In prior releases these syndromes had been modeled with an ASSOCIATED MORPHOLOGY = 19130008|Traumatic abnormality (morphologic abnormality)|; however, these syndromes may present due to non-traumatic etiologies such as space filling lesions (tumors, etc.) or vascular compromise (occlusions, ruptures, etc.). These syndromes have been remodeled with ASSOCIATED MORPHOLOGY = 52988006|Lesion (morphologic abnormality)|.
Incomplete cord syndromes with a traumatic cause have been remodeled to specifically represent 773760007 |Traumatic event (event)| as the DUE TO value as well as any other relationships to describe associated disorders (e.g. fractures or dislocations).
Malignant neoplasm
The content relating to Primary and secondary malignant neoplasms excluding Malignant tumours of lymphoid, hemopoietic and related tissues have been updated in line with the QI project objectives. This has resulted in an increase in sufficiently defined content and minor movement of previously incorrectly placed content into their appropriate hierarchies. Malignant tumours of lymphoid, hemopoietic and related tissue concepts will be addressed in the next release cycle along with any residual malignant neoplasm content.
Update Allergy to substance (finding)
As part of the QI project review of the 419199007 |Allergy to substance (finding)| sub-hierarchy and per the Allergies Clinical Reference Group recommendation, the concepts in this sub-hierarchy that represent allergy to "role groupers" and "Structure + role groupers" are being inactivated starting from the July 2020 release. Examples of these concepts are provided below:
- 294450008 Allergy to anthelmintic agent (finding)
- 294461000 Allergy to antibacterial drug (finding)
Content Tracker Project Updates
Work on hold on the following Content Project:
- IHTSDO- 393 Diabetes Complications - The Diabetes Project Group comprises practicing clinicians. As a result of the COVID-19 pandemic the majority of the participating clinicians have been drafted into supporting the response to this health care crisis. Consequently this project has been put on temporary hold until the pandemic is under control and healthcare staff are able to return to their normal duties.
Work completed for the following Content Project:
- IHTSDO-1157 Distinction between Pain and Tenderness. Improvement in the modeling of the Tenderness (finding) sub-hierarchy.
Improve modeling for 404177007|Angioedema and/or urticaria (disorder)| and descendants
Remodel 404177007|Angioedema and/or urticaria (disorder)| and descendants.
New morphology concept added 846575004 |Angioedema (morphologic abnormality)|
Changes for 'On Examination' and 'Complaining of' concepts
The 'on examination' and 'complaining of' content is being returned to the UK as part of the work for the January 2021 release. As part of this work, where no suitable replacement concept existed (without the examination or complaint component of the meaning) and the clinical meaning met editorial guidelines new concepts were added. This work was done over the January 2020 and July 2020 releases. For the July 2020 release this included the addition of 230 new concepts.
Update 17602002 Amyloidosis (disorder) and descendants
The modeling and terming of many amyloidosis disorder concepts were updated in the 17602002 Amyloidosis (disorder) sub-hierarchy.
Reactivation of 419952004 |Dermoid cyst (disorder)|
Existing concepts using the fully specified name "Cystic dermoid choristoma" have been inactivated and replaced with new concepts using the fully specified name "Dermoid cyst of X".
These concepts have all been inactivated:
- 441459009 |Cystic dermoid choristoma (disorder)| and all subtypes
- 416529009 |Cystic dermoid choristoma (morphologic abnormality)|
- 417137001 |Dermoid choristoma (morphologic abnormality)|
Rename FSN for concepts using 'Ecstasy' to Methylenedioxymethamphetamine
Ecstasy is not synonymous with Methylenedioxymethamphetamine (MDMA). Where “Ecstasy” is used in FSN and Causative agent is MDMA the concept has been replaced with a new or existing concept with FSN that contains MDMA. When “Ecstasy type drug” is used in FSN, regardless of causative agent the concept is replaced with a concept with FSN for “Amfetamine and amfetamine derivative (substance).”
Remodel 397803000 |Impotence (disorder) and descendants
397803000 |Impotence (disorder) has been inactivated and replaced with a new concept 860914002 |Erectile dysfunction (disorder). Subtype concepts that used the word 'impotence' have also been replaced with concepts that use the term 'erectile dysfunction.'
New concept 840358001 |High body weight (finding)| and realignment of subtypes
A new concept 840358001 |High body weight (finding)| has been added and has 2 subtypes that are siblings:
- 414915002 |Obese (finding)|
- 238131007 |Overweight (finding)|
The two latter findings of 'Obese' and 'Overweight' are mutually exclusive terms in the classification of BMI.
New concepts - Mental health
2 new concepts have been added after liaison with the Mental and Behavioural Health Clinical Reference Group:
- 'Depressive episode' has been removed as a synonym on 35489007 |Depressive disorder (disorder)|.
- New concept has been added 871840004 |Episode of depression (finding)|.
- New concept added: 833326008 |Cortical vascular dementia (disorder)|
Notice: |
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Content Tracker Project Updates
Work continues on the following Content Project:
- IHTSDO- 393 Diabetes Complications: Diabetic complications have now been updated and modeled according to the updated Editorial Guidance and use of "DUE TO".
Diabetic complications can be found in the hierarchy 74627003 |Complication due to diabetes mellitus (disorder)| which is a subtype of 116223007 |Complication (disorder)|. These concepts no longer reside as a subtype of 73211009 |Diabetes mellitus (disorder)|.
The ECL query which will give a list of all diabetic complications modeled with a "DUE TO" is as follows:*: 42752001 |Due to (attribute)| = <<73211009 |Diabetes mellitus (disorder)|
Work will begin with domain experts during the release cycle for July 2020 to update the clinical content in this area.
Other Areas of Quality Improvement in the Clinical Finding Hierarchy
Remodel concepts - 254666005 |Keratosis (disorder)| 782957005 |Ichthyosis (disorder)| 396228006 |Hyperkeratosis (disorder)|
These concepts were all defined with "hyperkeratosis" and "skin". There was duplication across the concepts with synonyms and modeling. After consultation with clinical experts the following was agreed in summary:
Hyperkeratosis and Keratosis are the same.
Ichthyosis has an underlying morphology of "keratosis" but with a different distribution pattern.
Changes for 'On Examination' and 'Complaining of' concepts
The 'on examination' and 'complaining of' content is being returned to the UK as part of planned work for the July 2020 release. Where no suitable replacement concept exists new content without the 'examination' or 'complaining of' component of the meaning is being created.
For example: Eye does not move left (finding) has been added in preparation for the inactivation of 'On examination - eye does not move left (finding)'.
For the January 2020 release 180 new concepts were added.
Inactivation - "Finding of form of X (finding)"
Inactivation of 30 concepts using the format "Finding of form of ..."
Remodel 70153002 |Hemorrhoids (disorder)|
Improvements made in the modeling of subtypes of 70153002 |Hemorrhoids (disorder)|.
Changes to Case Sensitivity
Over 31,000 descriptions have been reviewed and approximately 5,402 descriptions across 2806 concepts have had their case significance settings corrected as appropriate. The changes are across all SNOMED CT hierarchies but in particular disorder concepts (1774), procedure (978) and qualifier values (736). The Editorial Guidance on case significance related to descriptions containing numeric values and special characters has been updated for the January 2020 release.
'Co-occurrent and due to' pattern: During the implementation of the new Description Logic features, a conflict was uncovered between the modeling of 'Co-occurrent and due to' and General Concept Inclusions (GCIs). This has resulted in the need to reconsider the modeling of "Co-occurrent and due to' and update the Editorial Guide for this area. |
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The Editorial Guide and all concepts that are currently modeled as 'Co-occurrent and due to' will be updated over future |
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Convergent Medical Terminologies (CMT)
New CMT concepts: 775
The majority of these newly authored concepts are in scope for mapping to ICD-10 and from the following domains:
release cycles. |
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Convergent Medical Terminologies (CMT)
New CMT concepts: 714
- Injury - 162 concepts added.
- Ophthalmology - 552 concepts added.
- CMT Injuries - 106
- CMT Mixed Domains - 584
- CMT Musculoskeletal - 22
- CMT Ophthalmology - 20
- CMT Orthopedics - 43
Procedure
New concepts for procedure hierarchy: 105
Areas of Quality Improvement for the Procedure Hierarchy299
Implantation and Insertion procedures
Work
commencedcontinues on content tracker IHTSDO-175. There are ongoing structural changes
for the Procedure concepts related to the content tracker: It was agreed that not all Insertion and Implantation procedures are surgical. As a result, further work in the hierarchy under 129284003 |Surgical action (qualifier value)| has been undertaken for the January 2020 release and this includes:for the Procedure concepts related to the content tracker. Work on this project will continue for future releases after July 2020.
Content Inactivation - Anesthesia
These concepts have been inactivated from the International release and moved to the US extension:
- 67902001 |Anesthesia for a normal healthy patient (procedure)|
- 23102000 |Anesthesia for a patient with mild systemic disease (procedure)|
- 22211001 |Anesthesia for a patient with severe systemic disease (procedure)|
- 112989003 |Anesthesia for a moribund patient requiring operation (procedure)|
- 71191009 |Anesthesia for a patient with severe systemic disease, life threatening (procedure)|
Content Inactivation - Monitoring
These concepts have been inactivated from the International release and moved to the UK extension:
- 391023009|Osteoporosis - no treatment (regime/therapy)|
- 391030003|Osteoporosis - no treatment response (regime/therapy)|
- 391028000|Osteoporosis - treatment response (regime/therapy)|
- 391003008|Osteoporosis monitoring administration (regime/therapy)|
- 391004002|Attends osteoporosis monitoring (regime/therapy)|
- 391006000|Osteoporosis monitoring default (regime/therapy)|
- 391012005|Osteoporosis monitoring deleted (regime/therapy)|
- 391007009|Osteoporosis monitoring first letter (regime/therapy)|
- 391008004|Osteoporosis monitoring second letter (regime/therapy)|
- 391011003|Osteoporosis monitoring telephone invitation (regime/therapy)|
- 391009007|Osteoporosis monitoring third letter (regime/therapy)|
- 391010002|Osteoporosis monitoring verbal invitation (regime/therapy)|
Evaluation Procedure
- New evaluation procedure concepts - 10 (respiratory procedures, specimen processing and laboratory panels).
- Concept inaction - 13 (inactivated due to duplication or ambiguity).
- Reactivation of 129338005 |Surgical implantation - action (qualifier value)|
- Addition of a new concept 788288006 |Surgical reimplantation - action (qualifier value)|
- Remodel of 'Reimplantation procedures' replaced METHOD = 129337000 |Reimplantation - action (qualifier value)| with new 788288006 |Surgical reimplantation - action (qualifier value)|
Work on this project will continue for future releases after January 2020.
Evaluation Procedures
- Inactivated four duplicate concepts.
- Inactivated six ambiguous concepts.
- Inactivated one erroneous concept.
- Created one new concept to replace an ambiguous concept.
- Inactivated descriptions of sixteen concepts.
- Removed incorrect parent for two concepts.
- Added descriptions to fourteen concepts.
Changes to Existing Concepts in the Procedure Hierarchy
The following concepts and/or areas in the procedure hierarchy were remodeled:
- Osteopathic manipulation techniques
- Emergency coronary artery bypass graft
- Tylectomy
- Neck excision
- Procedure on brain ventricular shunt
- Change of diaper
- Removal of leeches
- Dermabrasion of facial scars
- Triennial health exam
- Detoxification therapy (regime/therapy)
- Hormone therapy replacement
- Transplantation of dura
- Cervical biopsy
- Excisional biopsy of cerebral meninges, percutaneous, needle
- Suture of plexus
- Oral fluorescence imaging
- Administration of heavy metal antagonist
Collaboration/Harmonization Projects
Orphanet
Working in collaboration with Orphanet (http://www.orpha.net/consor/cgi-bin/index.php), creation of new concepts for the original set of prioritized rare diseases has
been completedbeen completed.
The
mapping and validation process has begun for an alpha release after the January 2020 International release of SNOMED CT.alpha release is now available for feedback, for more information please see April 2020 SNOMED CT Orphanet Simple Map package ALPHA release available
All of the concepts added for the Orphanet project have been mapped to ICD-10
..
ICD-11 Update
A total of 593 new concepts were added for the July 2020 release.
Global Medical Device Nomenclature Agency (GMDNA)
2162 new device concepts were added to the physical object hierarchy for GMDN.
4 device concepts were inactivated.
ForFor the GMDN mapping equivalence tables:
- 21 New
- 62 new concepts have been added to inscope
- in scope and mapped. 161
- 156 concepts have been modified and removed from the mapping tool as out of scope. 92
- 95 concepts ave
- have been deemed obsolete and removed from the mapping tool and flagged as out of scope.
- 334 concepts were identified as no longer in scope for the map and have been removed. These concepts were identified as part of the Quality Improvement of the mapping equivalence tables and the monthly submissions from GMDN.
ICD-O-3.2 Update
For the January 2020 release, and based on the recent release of ICD-O-3.2 the priority has being adding new content for updated morphologies; this refers to additions to the 400177003 |Neoplasm and/or hamartoma (morphologic abnormality)| sub-hierarchy. Approximately 63 changes in the sub-hierarchy are related to the ICD-O-3.2 update analysis, including the direct addition of 25 new morphology concepts that were identified from analysis of the ICD-O-3.2 preview as missing from SNOMED CT.
Impacted concepts in the disorder hierarchy have been revised to align with any new ICD-O-3.2 morphology changes, and in many cases the addition of a relationship to the new morphology concept has resulted in the neoplasm disorder concept being defined fully. This work has included the creation of a small number of new neoplasm disorder concepts to match the new morphologies.
Descriptions with [obs] have been inactivated as outdated because they are artefacts of descriptions from the ICD-O-3 print version for their history tracking. There are two concepts and one synonym with [obs] that remain and will be addressed for the July 2020ICD-O-3.2 Update
A full Impact analysis of both updating the existing SNOMED CT content and updating the current ICD-O-3.1 map has been carried out. In particular this relates to changes to the 400177003 |Neoplasm and/or hamartoma (morphologic abnormality)| sub-hierarchy in SNOMED CT. The impact analysis utilized the final IACR ICD-O-3.2 (WHO IARC) morphology code listing and the new pdf changes documents on their website (http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577).
For the July 2020 release only minor changes have been made, and 14 new morphologies have been added to the 108369006 |Neoplasm (morphologic abnormality)| sub-hierarchy.
Note - The published maps to ICD-O-3.1 are being updated only for maintenance purposes for the July 2020 release. The maps to ICD-O-3.2 are out of scope for the July 2020 release and are planned for a future release.
Event
New concepts added:
16Qualifier Value
New concepts added: 88
4
Qualifier Value
New concepts added: 65
Occupation
Concepts representing "other" occupations e.g. 79445009 |Other clerk (occupation)| have been inactivated as ambiguous as these represent classification constructs.
Situation with explicit context
New concepts added:
31This includes 17 new concepts for 'History of X'.
Observable Entity
129
Physical object
New concepts added:
136This includes 8 new concepts for insulin dose observables.
Organism
New organism concepts added: 185
- Added new descriptions for 10 organism concepts.
- Inactivated 9 organism concepts as duplicates.
- Changed descriptions of two organism concepts.
Pharmaceutical / biologic product
icon | false |
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title | Drug model project |
89
For further details on the planned changes in this area, please refer to the Drug Model Working Group Directory section.
- Approximately 200 device concepts in the physical object hierarchy were modeled with the new device attributes in the areas of breast implants, shunts, stent, and cardiac valve prosthesis. Some of these concepts also had FSN and description changes.
- 25 concepts in the physical object hierarchy were inactivated.
- Approximately 630 attribute-value relationships were added to the physical object hierarchy including device characteristic such as sterility, absorbability, and custom-made.
- Editorial guidelines developed and documented and noted content updated accordingly. The guidelines are found on the project space: Reference Documentation - Devices (
- Please note, you may have to register for Confluence user account in order to access this project and the relevant
Changes for Pharmaceutical / biologic product
Inactivation of 'Over the Counter'
Concepts referring to “over the counter” status have been inactivated.
Concepts referring to regulatory status or characterization (e.g. over the counter) are out of scope for the International Release since the meaning may vary by jurisdiction and is not consistent internationally.
Vaccine Poisoning
Concepts referring to vaccine poisoning have been inactivated from the January 2020 International release and moved to the NHS extension per their request.
The notion of vaccine poisoning has persisted in ICD 10 under T50 but it is not included in ICD-11; the poisoning aspect seemingly referred to the adjuvants and carriers that are included in the vaccines as opposed to the biological component itself.
Information about upcoming changes to implement concrete domains in lieu of concepts representing numeric values will be available on the Modeling Advisory Group Confluence space located at:
https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group
- Editorial guidelines updated and distributed.
- Supporting documentation (e.g. Drug position statement, project roadmap) reviewed and updated as needed.
- Content updates including:
- Updated concepts for products with pegylated substances as active ingredient or basis of strength substance accordingly based on revised editorial guidelines for modeling pegylated substances.
- Updated concepts with non-conforming "million unit" expression of strength to be consistent with existing editorial guidelines.
- Reviewed modeling and made updates as needed for concepts using insulin groupers as an active ingredient or basis of strength substance.
- Implemented QA reports to identify content that does not comply with editorial guidelines; issues resolved or documented as exceptions in the editorial guidelines.
- Updates included normalization of strength expression, FSN and PT terming to correspond with Substance hierarchy, evaluation of relationship between BoSS and PAI, Medicinal product and Medicinal product form concepts modeled with substances that have modifications.
- Modeled product role for anti-infective agents and antiparkinson agents.
- Updated supporting documentation (e.g. SNOMED CT Medicinal Product Model Specification) as needed.
- Corrected MRCM rules for 774158006 |Has product name (attribute)| and 774159003 |Has supplier (attribute)|; they should be allowed for descendants of 373873005 |Pharmaceutical / biologic product (product)|.
- Editorial guidelines updated and distributed.
- Content updates including:
- Added/modified Pharmaceutical dose form concepts as needed or per CRS request
- Added text definitions for supporting hierarchies.
- link).
Specimen
New concepts added: 8
Concepts inactivated: 2
Observable Entity
New concepts added: 117
- 30 new concepts were added in the areas of novel coronavirus detection, insulin rates and doses, test due dates, minimum alveloar concentration.
- Estimate intake of X = 30 concepts new concepts
- Measured intake of X = 30 concept new concepts
- Proportion of X = 3 new concepts
- Target = 4 new concepts
Organism
New organism concepts added: 135.
Updated descriptions for 60 concepts.
Pharmaceutical / biologic product
Note | ||||
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For further details on the planned changes in this area, please refer to the Drug Model Working Group Directory section. Please note, you may have to register for Confluence user account in order to access this project and the relevant link |
Changes for the July 2020 International Release | |
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Concrete domain | Information about upcoming changes to implement concrete domains in lieu of concepts representing numeric values will be available on the Modeling Advisory Group Confluence space located at: https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group |
Vaccine products | Editorial guidelines developed and documented and existing content updated accordingly. The guidelines will be found on the project space Reference Documentation - Drug Model (Please note, you may have to register for Confluence user account in order to access this project and the relevant link). The updated Vaccine product concepts have been used to remodel content throughout SNOMED. Vaccine product "containing" concepts have been used in modeling "Allergy to X vaccine" and "Adverse reaction to X vaccine" patterns. Vaccine product "containing only" concepts have been used in modeling "Administration of X vaccine" pattern. Substance concepts referring to vaccines have been inactivated in lieu of the Vaccine product concepts. Product role attributes added to products used for passive immunization. |
Veterinary Extension
23 concepts were moved to the Veterinary Extension.
Metadata concept
In order to support the upcoming RF2 version of the GPS (Global Patient Set) refset, the GPS requires its own moduleID.
A new concept has been added to support this use case 890195008|International Health Terminology Standards Development Organisation Global Patient Set module (core metadata concept)|
Substances
New concepts added: 137
- New disposition concepts: 7
- Inactivated Allergen class groupers from the Substance hierarchy.
- Inactivated Vaccine substance groupers from the Substance hierarchy
Veterinary Extension
7 concepts were moved to the Veterinary Extension.
Social Context
New concepts added: 1
Specimen
New concepts added: 3
Substances
New concepts added: 223
As a Vaccine project work item and based on requests submitted mutually by Argentina and Canada, 151 new antigen concepts have been added to the Substance hierarchy to be used in the modeling of vaccine products in a future release- .
Note | ||||
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For further details on the planned changes in this area, please refer to the Substances project. Please note, you may have to register for Confluence user account in order to access this project and the relevant links above. |
Internal Quality Improvement
Replacement of the Stated Relationship files with the new OWL Axiom refset files
A set of documentation has been developed to support the Logic Profile Enhancements.
- SNOMED DL Profile Enhancements
- SNOMED CT Logic Profile Specification
- SNOMED CT OWL Guide (OWL Refsets specification)
- Snomed OWL Toolkit - https://github.com/IHTSDO/snomed-owl-toolkit
- Classifying SNOMED CT using the Snomed OWL Toolkit - https://youtu.be/-91egY9mJqA
- Creating an OWL file containing SNOMED CT - https://youtu.be/sfFbMMioA_4
For any questions, please contact SNOMED International at support@snomed.org with “OWL Axiom refset files implementation question” in the subject line.
Machine Readable Concept Model (MRCM) Changes
3 updates Changes to the existing MRCM in the MRCM refsets and authoring platform were made for the January July 2020 release include:
- MRCM for new attribute 860779006 |Has ingredient characteristic (attribute)|
- MRCM for new attribute 246196007 |Has surface characteristic (attribute)|
- MRCM for new attribute 827081001 |Has filling (attribute)|
- MRCM for new attribute 836358009 |Has device intended site (attribute)|
- MRCM for new attribute 840560000 |Has compositional material (attribute)|
- MRCM for new attribute 840562008 |Has device characteristic (attribute)|
- MRCM for new attribute 860781008 |Has product characteristic (attribute
- Expand the range of 246501002 |Technique (attribute)| to include << 273249006 |Assessment scales (assessment scale)|.
- Expand the domain of 774159003 |Has supplier| to 373873005 |Pharmaceutical / biologic product (product)|
- Expand the domain range of 774158006 |Has product name246075003 |Causative agent (attribute)| to include << 373873005 |Pharmaceutical / biologic product (product)|.
Further details detail can be found here MRCM changes in the January 2020 at https://confluence.ihtsdotools.org/display/IAP/MRCM+changes+in+the+July+2020+release (Please note, you may have to register for Confluence user account in order to access this project and the relevant links above).
Improvement for the Representation of Role Groups
It is important to clearly indicate if an attribute is grouped or not because role grouping has impact to semantics and classification results. The majority of the Modeling Advisory Group members recommended explicit representation for role groups. Two key changes have been implemented since the July 2019 release.
Firstly, role groups are explicitly stated and represented by the concept 609096000|Role group (attribute)| as an object property in the OWL axiom refset.
Secondly, for the inferred relationship file, role group 0 is only applied to attributes that are not logically grouped. The attribute is not a value of 609096000|Role group (attribute)| in an OWL axiom. Or the attribute has grouped = 0 in the MRCM. This addresses the potential confusion whether an attribute is grouped or not in role group 0.
The improvements provide consistent representation for role groups in the OWL axioms, inferred relationship file and diagramming of the concept model.
Concrete Domains and Numeric Representation
The Modeling Advisory Group is working on concrete domains and how they will be represented in the inferred RF2 relationship file format. The following is a note on the interim solution relating to concrete domain for the medicinal product model:
Numerics are represented by concepts in the Medicinal product concept model in SNOMED CT, which is an interim solution before the implementation of concrete domains to support data types, such as decimal, integer, string and date/time. We are in progress for progressing the development of the specification for the inferred relationship file and consult in consultation with the community of practice. When they are ready, strength in the medicinal product model can be transformed to concrete domains. The transformation will be completed by technical changes without impact to classification results.
The further Further information about current progress on Concrete Domains can be found at:
https://confluence.ihtsdotools.org/display/mag/Modeling+Advisory+Group (Please note, you may have to register for Confluence user account in order to access this link).
SNOMED CT derived products
ICD-10 map
The SNOMED CT to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (© World Health organisation Organization 1994) 2016 Version map (SNOMED CT to ICD-10 Map) is included in the SNOMED CT International release as a Baseline. The SNOMED CT to ICD-10 Map was created to support the epidemiological, statistical and administrative reporting needs of SNOMED International member countries and WHO Collaborating CentresCenters.
The SNOMED CT to ICD-10 Map is released in Release Format 2 (RF2) only. It is located in the file der2_iisssccRefset_ExtendedMapFull_INT_2020013120200731.txt, which is in the Map folder under Refset, in each of the three RF2 Release Type folders.
The SNOMED CT to ICD-10 Map is released as Refset 447562003 |ICD-10 complex map reference set (foundation metadata concept)|.
Content development activity summary
The map is a directed set of relationships from SNOMED CT source concepts to ICD-10 target classification codes. The SNOMED CT source domains for the MAP are limited to subtypes of 404684003 |clinical finding|, 272379006 |event| and 243796009 |situation with explicit context|. The target classification codes are ICD-10 2016 release.
Mapped content for July 2020
The map provided for the July 2020 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2016
release.Mapped content for January 2020
The map provided for the January 2020 release has been updated, and now represents a complete map from SNOMED CT International release to ICD-10 2016 version.
version.
- 2223 new concepts added
We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@snomed.org
Technical Guide Exemplars
The Technical Guide Exemplars document has now been moved from the International Edition release package to a Confluence page. This page can be found as part of the ICD-10 Mapping Technical Guide (see Appendix B), which is hosted here: http://snomed.org/icd10map
ICD-O Map
For the July 2020 release only minor changes have been made, and 14 new morphologies have been added to the 108369006 |Neoplasm (morphologic abnormality)| sub-hierarchy.
The published maps to ICD-O-3.1 are being updated only for maintenance purposes for the July 2020 release. The maps to ICD-O-3.2 are out of scope for the July2020 release and are planned for a future release.
SNOMED CT to OWL conversion and classification
The repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit
Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.
Technical notes
Known Issues
Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented. This can be due to a number of reasons, from lack of capacity within the current editing cycle, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.
For the SNOMED CT July 2020 International edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:
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Resolved Issues
Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release. They can also be issues found during the Alpha and Beta testing of the current release, which were resolved before the final deployment of the associated Member release. Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.
The Resolved Issues for the Snomed CT July 2020 International edition can be found here:
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Technical updates
RF2 package format
For future reference, the RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release. Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record). The reason that these files are not removed from the package is to draw a clear distinction between files that:
- have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and
- happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.
This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.
New Configuration file in the RF2 package, containing Release Metadata
A new file will be included in the July 2020 International Edition (and all subsequent releases), containing metadata about the Release package itself. This has been created in conjunction with feedback from the community, and as such will initially contain the following fields:
- effectiveTime
- deltaFromDate
- deltaToDate
- languageRefset(s)
- humanReadableLanguageRefset(s)
- licenceStatement
The file will be in .JSON format, to ensure that it is both machine-readable and human-readable. It will be named "release_package_information.json".
The metadata will be extended and refined going forward, in order to ensure that it contains the most useful information possible. If anyone has any ideas about any other useful information to include, please send them to info@snomed.org, along with a business case explaining how the information would benefit stakeholders. Please be aware that this use case will then be assessed by SNOMED International, and the new metadata will only be included in the configuration file if the business case is strong enough.
Additional Rollup Delta Release package
Note |
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As part of the July 2020 International Edition Release, SNOMED International will also be publishing an additional, optional package. |
For those users who did NOT use the March 2020 Interim International Edition release in their systems, the advise on bringing systems up to date is as follows:
- The best option is to first apply the March 2020 Interim release Delta files (relative to the January 2020 release), and after that apply the official July 2020 Delta files (relative to the March 2020 Interim release).
- If this is not feasible, then please use the July 2020 International Edition additional Rollup Delta package - please see the Release Notes for full details:
Early visibility of impending change in the July
Map QA project 60, 328 concepts have been reviewed for inconsistent map advice. The focus was the SNOMED to ICD-10 Chapter X1V Diseases of the genitourinary system (N00-N99).We would welcome feedback on any issues that users of the map may detect when using the map. Issues should be submitted via mapping@snomed.org
Technical Guide Exemplars
The Technical Guide Exemplars document has now been moved from the International Edition release package to a Confluence page. This page can be found as part of the ICD-10 Mapping Technical Guide (see Appendix B), which is hosted here: http://snomed.org/icd10map
ICD-O Map
The maps to ICD-O-3.1 are being updated only for error correction purposes for the January 2020 release. The maps to ICD-O-3.2 are out of scope for the January 2020 release and are planned for a future release when the ICD-O-3.2 classification has been published by WHO (IARC).
As part of the initial QA process 34 ICD-O-3.1 morphology maps to grouper concepts with "- category" in the FSN were removed and assigned a 'no target' map in preparation for the ICD-O-3.2 update.
For the January 2020 release a total of 69 morphology concepts in the 400177003 Neoplasm and/or hamartoma (morphologic abnormality) sub-hierarchy were mapped. 31 were mapped to ICD-O-3.1 morphology codes and 38 assigned a 'no target' map (consisting mainly of new morphology concepts) awaiting the ICD-O-3.2 update and availability of new codes in the mapping tool. For example new concept 788565009: Indolent T-cell lymphoproliferative disorder of gastrointestinal tract (morphologic abnormality) has no target map until ICD-O-3.2 is available but the new morphology has been used to fully define the disorder concept 783565007 Indolent T-cell lymphoproliferative disorder of gastrointestinal tract (disorder).
SNOMED CT to OWL conversion and classificationThe repository containing the toolkit enabling simple SNOMED CT to OWL conversion and classification can be found here, including documentation on its use: https://github.com/IHTSDO/snomed-owl-toolkit
Please contact SNOMED International at support@snomed.org if you would like to provide any feedback on ways to extend and improve the new toolkit.
Technical notes
Known Issues
Known Issues are content or technical issues where the root cause is understood, and the resolution has been discussed and agreed but has yet to be implemented. This can be due to a number of reasons, from lack of capacity within the current editing cycle, to the risk of impact to the stability of SNOMED CT if the fix were to be deployed at that stage in the Product lifecycle.
For the SNOMED CT January 2020 International edition, the following Known Issues were identified, and agreed to be resolved in future editing cycles:
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Resolved Issues
Resolved issues are Known Issues which were not fixed as part of the previous release lifecycle, but which have now been resolved in the latest release. They can also be issues found during the Alpha and Beta testing of the current release, which were resolved before the final deployment of the associated Member release. Finally they can be issues which were reported or found during the testing phase, but which have been closed without any action taken.
The Resolved Issues for the Snomed CT January 2020 International edition can be found here:
Jira | ||||||||||
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Technical updates
RF2 package format
For future reference, the RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release. Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record). The reason that these files are not removed from the package is to draw a clear distinction between files that:
- have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and
- happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.
This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.
Early visibility of impending change in the January2020 International edition
Please see the following page for details of all upcoming changes planned for January July 2020 and beyond: January 2020 Early Visibility Release Notices - Planned changes to upcoming SNOMED International Release https://confluence.ihtsdotools.org/display/RMT/July+2020+Early+Visibility+Release+Notice+-+Planned+changes+to+upcoming+SNOMED+International+Release+packages.
Release Notes naming convention
The Release notes naming convention has been refined to bring it in line with other documentation standards - from this release onwards the files will have the following naming format:
- doc_SnomedCTReleaseNotes_Current-en-US_INT_[date].pdf
Instead of the previous underscore after "Current":
- doc_SnomedCTReleaseNotes_Current_en-US_INT_[date].pdf
Document links
All links provide information that is correct and current at the time of this Release. Updated versions may be available at a later date, but if so these will need to be requested from the relevant SNOMED International teams.
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NOTE: To access any of the links in the pdf document, please visit the Release Notes @ https://confluence.ihtsdotools.org/display/RMT/SNOMED+CT+JanuaryJuly+2020+International+Edition+-+SNOMED+International+Release+notes |
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Approvals
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Draft Amendment History
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Draft Amendment History Version Date Editor Comments 0.1 20191015 Andrew Atkinson | First draft for review and comment 0.1 20191126 | Maria Braithwaite / Andrew Atkinson | Final updates, including map record count update | 0.2 | 20191204 | Maria Braithwaite / Yongsheng Gao | Beta updates, including OWL effectiveTime explanation |